Episode : #976: How To Climb Out Of This Sticky Billing Spot

Podcast Description

Kiera shares exactly how Dental A-Team helped a practice with over $2 million in accounts receivable break even — and learn how to never fall behind again.

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Transcript

Kiera Dent (00:01.848)

Hello, Dental A Team listeners. This is Kiera and welcome to the podcast. I hope today you are truly just so happy. I hope that you are honestly just living your best life and I hope you know that you're truly doing better than you think you are. So you guys, this is where we are. We're here to help you. Dental A Team is obsessed about helping you and your team thrive. To be able to give you guys the guidance that you need to navigate the challenges that we have in dentistry. so welcome. This is what I'm obsessed with. I hope that you just know that I

I truly love and adore this podcast family. I'm so grateful for you. I'm grateful for you sharing this with your friends. I love, love, love seeing you tag us when you're driving to work or listening in the car or taking us on a road trip. And my goal is to be always something of value for you on this podcast that you can go and implement immediately to make your life and your practice even better. For those of you new, welcome. For those of you who are OGs, welcome. I'm so happy to have you here. As always, please.

like and subscribe and leave reviews for our podcast. That way we can reach all the practices truly out there. Right now we have impacted several, but I know there's thousands of other practices that we could reach and guide. And the only way I can do that is through your help of sharing this. So as always, if you've shared, thank you. I just gave you a high five or a hug to say thank you. And I'm so glad that you're here. All right. Today I'm going to give you some quick tacticals on some billing help.

how to handle old balances. think old balances are just annoying and I help practices with this all the time. Just to give you a little story, I kind of like stories on podcasts. I'm usually I'm here to rattle and roll and today I want to just take you down a little bit of memory lane. But there was a practice who reached out to us and wanted us to be a consultant for them and asked us to help them with their billing department. And I was like, all right, sure, like we do this. I'm more than happy to help you out. Let me know what you need. And this practice said,

Well, Kiera, our over 90 and our total amount is about 2 million. And I was like, that's all right. It's not the worst I've ever seen. Tell me a little bit more. And they said, we literally have no handle on what we're doing with billing. And I was like, fantastic. So we got on. We started working with, they had a few different practices, 2 million. Could you imagine? Like, this is why I get paid what I get paid. Because we go and we find these little money holes in the practice and we patch them up.

Kiera Dent (02:20.622)

and we're able to add all this money back into your practice and to help you put systems into place so this doesn't happen again. I think that's the biggest thing is let's make sure this does not happen again. And so with this practice, what we ended up doing was we started checking in Trulie every single week with this billing team. We created spreadsheets. We had them download the AR.

We prioritize which balances for them to go after first. And then we started like just chipping away at it. And we were heavy on our accountability. You better believe that I was hot to try on this practice. And it was every single week I was getting a report and update how many claims that they worked through. We looked to see, I think we had over 5,000 accounts to go through. So what we did is we said, all right, I'm gonna grab my calculator. I don't know off the top of my head. We said, all right, 5,000 accounts. We are working 20 days.

That means we need to get through 250 accounts per day. We had three people working on it. That meant 83 accounts per person. Now that's not realistic, right? And so what we did is we took those 5,000 accounts and we did that over three months before we ran a new AR account. That way they could feel like they could get through that because then you have 5,000 charts. We have 60 days to work, right? 20 days times three. And then we had three people working on it that broke it down to about 25 to 30 accounts per day.

that felt a lot more doable. Now remember, a lot of these accounts just needed to have a resubmit from insurance. It was a denied insurance claim because we didn't attach an attachment. Others, we just need to call and collect from a patient. Others, there was more work that needed to be done that we had to dig into. And then there was the dun-dun-dun-dun, old accounts. Like, what do I do with these old balances? We can't collect on them. And so that's really where we started to work. And so with this practice, it took us

Truly, I'm not exaggerating, it was about six months before we started to get a good handle on it. And then like at a year mark, they felt like very confident we were able to get through all the accounts. We had good processes in place. We started collecting when people were coming in the door and that way all those accounts of this billing team looked to see who on the schedule we could collect from. Because that then, instead of just these three people working on it, we also had all of our front office team working on it, all the back office team, we were prepping the route slips.

Kiera Dent (04:33.774)

which a lot of billers will tell me that just feels like a waste of time, Kara. I don't want to do that. I don't want to prep these charts. And I think, yeah, but think you probably see, I don't know, 25 to 70 patients per day. And if we could collect on all of those that come through and collect those balances, well, now I'm not having to go and like look for all this stuff everywhere else. I can just get this done like in real time. So again, I'm a person of let's work smarter, not harder. And so this practice started doing that. So that became a system of then we chart prep.

consistently making sure that, my gosh, like let's get all these patients there. We put into a process for the front office to collect at time of service when they checked in. And then we also made sure that we were really good on our treatment estimates to make sure that we didn't get into this hot water. And the reason this office got into hot water is not because they were doing anything wrong, but because this practice did not consistently work there.

their insurance. And so they got all these old accounts, they got all these old balances. And guess what? That's no fun for anybody. That's not fun for the patient. That's not fun for the practice. That's not fun for cashflow. That's not fun for the billers. I mean, gosh, like when I look at 5,000 accounts, I'm like, all right, we got to work. Like we've got our spreadsheet to get through. And so for these practices, I just want you to know that no matter where you are, there's still hope. If we can help you on that, by all means reach out. Even if you're not there yet, like that far.

Let's great, like let's catch it because the ultimate goal is that you have no more than one month's worth of production in your total AR. So if you're producing a hundred thousand, then guess what? I want no more than a hundred thousand in your AR at any given moment. Also, I really watch your over 90 accounts because those can tip to where they're no longer collectible. So what I recommend we do is when I'm working with a billing team is we're going to start with those big balances and then like, let's make a big hit. Like let's do a good impact.

So I have people put it on an Excel spreadsheet. We have it color coded. It's actually so simple. And once billers get into this rhythm and doctors, when you have it, it becomes truly like flawless. It's so beautiful. It's so easy to do. So we put it in there. We sort it. You can use it and sort the list and sort your AR list. So that way I can look usually within your over 90. It's usually held up in like five to 10 accounts. So what we do is we actually go hit those accounts that are going to give us the biggest bang for our buck and our time.

Kiera Dent (06:48.238)

and we're gonna go try and collect on those accounts, figure out what's going on with those accounts and try to collect. Now, when I have an office that has a lot of really, really, really old balances, there comes a question of, we just write this off as bad debt or do we try to collect? And my opinion is you did the work, let's try and collect whatever we possibly can. So on those offices, I usually send out statements. You'll be shocked at how much you actually can collect from those old balances, that old debt.

And then we go, we try to collect, I usually send one, two or three statements, depending upon the practice and the doctor's choice. I do not think it's aggressive to send three statements. I also call, I'm making sure I call these patients. You can even let them know like, hey, we're updating our system and we noticed there was an outstanding balance. So we needed to get that collected for you. This is the total. And I can take Visa or MasterCard, which do you prefer? Collect right over the phone. It's very simple. I know it feels weird. It's like, my gosh, we were supposed to have collected this a while ago.

Well, high five, we updated our system. Hashtag we updated to actually looking at it is what we're trying to tell people. We should have collected this. We didn't, but now we have a process in place where we do this every week. And then from there, what I like to do is have you guys truly start collecting on those calling. I am amazed at how many practices do not call. Also amazed at how many practices do not have an online payment portion. Well, that's a really easy way to get old balances. Cause if you're expecting them to call during working hours or send you a check,

or write their credit card on a little piece of paper and send it back to you. Well, we've just made it to where it's like so much of a time delay. Why not just have them get on the phone, get on a call with you and start making the outbound calls. I just gave you the script, use that for your team. That's how we start to work with these old balances. So now we've tried to collect everything. We're working on it. I also am very sticky that our billers are working at least two days a week. Billers, I'm going to tell you, you can work more efficiently. And I say that with grace and love and a hug.

Because I don't want you working on this all the time. What I want you doing is I want you clumping things together, clumping insurance plans together, looking for all the patients that I can call, working A to J and then my, what is it? JK, K to Z. So we work those every other week. We're sending out statements, we're sending out text messages, and we have a rhythm. I have a billing calendar that I share with offices so that way we don't get off track. Yeah, you're going to have some hard work to do at the beginning, but once we get this on track and we have a system, guess what? You'll have to work on it like two days a week.

Kiera Dent (09:08.75)

It really does cut down time and doctors, just so you know, again, that's pending upon the size of the practice. When we have multi-offices, it's a full-time job. When we're at one practice, one provider, it should be a two-day job for billing. Now billers might hear this and they might be angry with me. Billers, I'm saying that not because I think that you are doing things wrong. I'm just saying that most offices can do it that way. So let's give you the efficiency tips. Let's help you out. Let's make sure that you're able to do it too. That way you're able to...

Do this in the most effective and efficient way as possible. My goal is to not waste time. Let's not waste time on hard things, but let's actually do things that are fun. You can also outsource this to third party companies as well. That can also help. They're working. They're hugely less expensive. So if you're struggling with billing, those are some solutions. So I promise you old balances. We've now gone through, we've done all this. We still have debt.

We still have these balances that we can't collect. We've sent out our three statements. We've been contacting them. We've called them three times. This has also been documented in their ledger. So we know it's really been done. Doctors, can run reports when it's documented. I usually do made up codes for these, but that way doctors, can run reports to see how many of these procedures are actually being, or how many of these calls are being done consistently. okay. Now it's a choice. You have choices. So depending on how old it is, what I usually like to do is I run my AR report.

And then doctors, it's your decision here. I'm not going to tell you what to write off. All this money is technically owed to you. You did the work, so you get to decide what you want to do. I'll tell you my preference and I'll tell you what I usually recommend. But at the same time, this is your money and I want you to know you are entitled to every single penny that has been billed in the practice. I usually recommend anything below $20. If we can't collect it, it's not there. There's no way for us to collect it. Just write it all off. I also like to do this at a strategic time point.

where it's probably at end of year or end of quarter. So that way I know at this point in time, I wrote off all this bad debt because then we can move forward and we know that was like a bad time. We're never doing it again, but this was my one time. So anything $10 or less, $20 or less, just write that off, get that out of the accounts. It's gonna clear up quite a few accounts for you. Then, well, and before we do that, we've tried to collect also any person who has a balance on their account.

Kiera Dent (11:27.79)

I don't usually think sending someone to collections over $20, that's not my jam. I'm not usually a big proponent of collections, but again, every penny is entitled to you. So you decide what's best for you. So we write it off and then from there we get to start deciding what we're gonna do. Are we gonna call these patients and do a 50-50 split with them to where if they pay 50 % today, we're then gonna write off the additional 50%, but most likely they're probably not welcome back in the practice. Are we going to send them to collections?

Are we just going to say these balances are never going to be collected? And we like pick through them and decide, but doctors, once we have this bad debt, it's your decision to decide what are you going to do with it? Look to see how much it's there. Look to see how much we've contacted them, called them. Can we do anything else? And then we really get to decide, we write this off? Now, if you do write it off for bad debt, it does need to be adjusted off. There needs to be a note on that practice, on that patient. And that patient does not get to come back to the practice until they've paid their debt. Let's not get ourselves back into hot water.

but that's how we're gonna handle these old balances. And I know this feels like icky sticky, but when we get to this, like that practice, we worked on it six months, eight months, nine months. At the end of the year, we decided, we showed the doctor, we said, this is all, this is everything we've collected from this 2 million pile of these 5,000 accounts. And here we are. And I think we ended up writing off about $50,000 at the end of it, which that feels like a bad day, but $50,000 out of 2 million, I think they did a really, really great job.

We had bad systems in place. We didn't have people collecting consistently. And that was the reality of where we got. But they then moved forward and we made sure we were at 98 % collections. We kept that claim amount low. We kept our AR low. We made sure we never got over one month's worth of AR ever again. And this practice is happy skipping along, but it was hard work. So I want you to know that it is tricky, but it is doable. And this is hopefully a quick tip for you of how you're able to handle those balances.

Now there's a lot of other pieces, there's a lot of other options, there's a lot of different things. I just kind of gave you a highlight reel today that hopefully will take you through to see, all right, what is my AR? Am I at one month or less of my AR? What are my highest balances? And what are my oldest balances? Can I get those collected? And then what do I need to start writing off? So those would be some of my quick highlight tips for you to get started. You know at Dental A Team, our passion is making sure that you are so successful.

Kiera Dent (13:44.76)

that you're able to have the know-how, the things that you need to do, the things that will make you the most successful, and also the less stressed, and also to help your team, because I know doctors, you're not taught this in dental school, this is really tricky, and so this is what we're able to do. We're able to work with your billing team, we're able to work with your teammates, and the entire practice, including yourself, to understand A, what is the process, B, how do we get ourselves out of this mess, C, how do we never get there again, and D, how do we make sure that this is something that...

literally becomes a system that is forever running rather than something that's person dependent. So that's what we're about. If that resonates with you, I'd love to hear from you. [email protected] or just go to our website and click on a call or DMS. Either way, I'm happy to help you. If you're in a billing sticky spot, I'm happy to assess it with you, give you some free guidance, get you on your way, but always reach out. [email protected] And as always, thanks for listening and I'll catch you next time on The Dental A Team Podcast.